Prognostic factors in the prediction of survival following TIPS for cirrhosis and refractory ascites

Objective To analyse the prognostic factors of survival in patients with cirrhosis and refractory ascites treated with TIPS.Methods From January 2003 to February 2009, a cohort of 25 hospitalized patients with cirrhosis and refractory ascites treated with TIPS were retrospectively studied, and data were abstracted including baseline characteristics of patients and all biochemical variables within 7 days after being referred to our hospital.The major endpoints was death.Cox proportional hazards method was used to assess the prognostic value of the variables found to be significant in univariate analysis.For those variables, cut-off values according to ROC curves, were determined so as to get a sensitivity over 80%.Results The median time of follow up was 18 months (range 1-40 months) , 6 patients died and no liver transplantation was performed within the first year of follow up.The cumulative 3-month and 1-year survival rate were 84% and 67% respectively.Using multivariate analysis, only serum bilirubin and creatinine levels were independently associated with 1-year survival.According to ROC analysis, we selected the cut-off values of 46 μmol//L for serum bilirubin level (sensitivity = 86%, specificity = 35%) and 132 μmol//L for serum creatinine level (sensitivity = 83%, specificity = 33%) .In addition, Kaplan-Meier survival analysis demonstrated that the 1-year cumulative survival in patients with serum bilirubin level <46 μmol/L was 92% as compared to 37% in patients with serum bilirubin level ≥46 μmol/L (P<0.001) .The 1-year cumulative survival of patients with creatinine <132 μmol/L was 89% versus 43% for ≥132 μmol/L (P<0.05) .Conclusion A serum bilirubin level above 46 μmol/L and creatinine above 132 μmol/L are prognostic factors in patients with cirrhosis and refractory ascites treated with TIPS.This simple score could be used at bedside to help choosing the best therapeutic options.